Migrainous infarction

Shuu-Jiun Wang MD (

Dr. Wang of the Brain Research Center, National Yang-Ming University, and the Neurological Institute, Taipei Veterans General Hospital, received consulting fees from Eli Lilly, Daichi-Sankyo, and Novartis.

)
Originally released July 1, 1993; last updated November 2, 2018; expires November 2, 2021

This article includes discussion of migrainous infarction, complicated migraine, migraine-induced stroke, migraine with cerebral infarction, migrainous stroke, and migraine-related stroke. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

In this article, the author updates the topic of migrainous infarction, including the diagnostic criteria proposed by the International Classification of Headache Disorders, 3rd edition, 2018. The summary also reported good outcomes of a recent Mexican study on a group of 15 patients with a mean follow-up of 7.5 years.

Key points

 

• Migrainous infarction is a rare complication after usual attacks of migraine with aura with a documentation of neuroimaging findings, such as MRI. Cortical laminar necrosis is one of the MRI findings.

 

• The incidence of migrainous infarction is very rare, estimated as 3.36 per 100,000 person-years according to the strict criteria proposed by the International Headache Society.

 

• Migrainous infarction mostly occurs in the posterior circulation and in younger women with a history of migraine with aura.

 

• The majority of patients present with visual prolonged aura, and the stroke severity is mild with a good outcome.

 

• The pathologic mechanisms responsible for migrainous infarction remain unproven. One case report suggests a continuum between migraine aura and stroke by cortical spreading depolarization.

 

• The long-term outcome is good for patients with migrainous infarction.

Historical note and terminology

Migraine attacks are occasionally accompanied by stroke. Permanent neurologic deficits associated with attacks of migraine were reported as early as the 19th century. Charcot first used the term "complicated migraine" (Charcot 1890), and Galezowski reported persistent visual sequelae (Galezowski 1881). Hunt wrote a classic paper concerned with permanent paralysis along with other neurologic complications of migraine (Hunt 1915).

The diagnosis of migrainous infarction is based on the abrupt onset of a neurologic deficit during a migraine attack associated with evidence of cerebral infarction on neuroimaging. Other causes of stroke must be excluded. Strict criteria for the diagnosis of migrainous infarction must be applied because migraine is common and patients with migraine may suffer from other causes of stroke. The diagnosis of migrainous infarction should be made only when a patient with an established history of migraine suffers a cerebral infarction during a typical migraine attack (Rothrock et al 1988).

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